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Pain Management > Unit 2 > Flashcards

Unit 2 Flashcards

1
Q

what are the 5 traditional methods of pain control

A
  1. removal of cause
  2. psychosomatic methods
  3. use of a drug to block the pathway of the painful stimulus
  4. raise the pain threshold
  5. depression of the CNS
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2
Q

how can we as hygienists help remove the cause of pain

A
  • temporary pain: blade angulation

- continuous pain: further investigation needed!

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3
Q

what are psychosomatic methods of pain control

A
  • verbal instructions, suggestions, hypnosis, relaxation techniques, distraction will lessen patient’s pain reaction, but not pain alone (pain perception)
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4
Q

what can we as hygienists do with drugs for pain control

A
  • topical and local anesthetic used to block the impulse before it is carried to the CNS
  • this interferes with pain perception which lessens or eliminates pain
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5
Q

how can we raise a patient’s pain threshold

A
  • by using drugs that provide “conscious” sedation
  • ie. nitrous oxide, narcotics, barbiturates, psychosedatives
  • can be used alone or in combination
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6
Q

how can we depress the CNS for pain control

A
  • general anesthetic agents depress the entire central nervous system -> causes total elimination of reaction to pain
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7
Q

how do we achieve topical anesthetic

A
  • direct application of anesthetic agent onto mucous membranes
  • agent is absorbed by free nerve endings creating anesthetic effect
  • topical is easily absorbed by blood vessels in the area
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8
Q

which is more likely to have a toxic reaction, topical or local, and why

A
  • more likely to occur with topical
  • why: higher concentrations than local and when applied in vascularized areas (floor of the mouth) rapid absorption occurs
  • DO NOT APPLY TOPICAL ON LINGUAL SURFACES OF MAND OR FLOOR OF THE MOUTH
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9
Q

what are the 3 different forms of topical anesthetic and when do we recommend using each

A
  1. gels: recommended prior to local anesthetic or during scaling
  2. liquids: recommended during scaling
  3. sprays: discouraged to use due to difficulty to control. pt and clinician may inhale the agent
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10
Q

what is the most common complication involving topical and why

A
  • tissue irritation due to high concentration
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11
Q

what are the 2 uses of topical anesthetics

A
  1. preinjection

2. during a scaling procedure

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12
Q

what is the process of applying topical for preinjection

A
  • dry area
  • apply small amount of topical with cotton-tipped applicator for 1-2 minutes in specific area
  • dry or rinse away
  • pressure anesthesia or schema is produced by applying pressure with cotton-tipped applicator prior to palatal injections to minimize pain
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13
Q

what is the process of applying topical during a scaling procedure

A
  • most effective way to get localized topical anesthesia in gingival sulcus is with topical (ie. oraquix)
  • carry liquid topical to the bottom of a dried sulcus with a curette or applicator for recommended time, then rinse
  • if you find the need to use in most sulci then use local anesthesia to decrease risk of toxic reaction
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14
Q

why do we use local anesthetic

A
  • chemical agents that produce short and completely reversible loss of sensation in specific area
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15
Q

what are the 9 desirable properties of local anesthetics

A
  1. sterile agents
  2. stable in solution but bio transformed in body
  3. non-irritating to the tissues
  4. will not cause permanent damage to the nerve
  5. low systemic toxicity
  6. low potential for producing allergic reactions
  7. adequate potency without use of harmful concentrations
  8. rapid onset of anesthesia
  9. long duration enough to permit completion of procedure
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16
Q

when should we use local anesthetic (6 points)

A
  1. if patient exhibits low pain threshold
  2. extensive treatments (high degree in quadrants/sextants)
  3. root planing or soft tissue curettage
  4. localized areas of extensive perio involvement
  5. abundant bleeding making visibility difficult (use of vasoconstrictor)
  6. any procedure that will produce pain
17
Q

what is important to know before using local anesthetic on a patient

A
  • thorough knowledge of patient’s medical history
  • thorough knowledge of possible complications
  • thorough knowledge of anesthetic agent and vasoconstrictors
  • contraindications, ie liver dysfunction = no AMIDE or uncontrolled hyperthyroidism = NO vasoconstrictors
  • knowledge of drug interactions (multiple medications)
18
Q

when can we use nitrous oxide

A
  • may be used for restorative, deep sub gingival scaling, root planing, soft tissue curettage
  • health history is essential
  • recognition of need for nitrous prior to local anesthetic
  • for patients with low pain threshold and very anxious
  • been used for more than 100 years in dentistry
19
Q

how does nitrous oxide work and what must we do when patients are using nitrous oxide

A
  • affects CNS by depressing the cerebral cortex, thalamus, hypothalamus, and reticular activation system
  • nervous impulses no longer being relayed to cortex or interpreted differently
  • patient must NOT lose consciousness during sedation
  • monitor vitals continuously
20
Q

what are the benefits if nitrous oxide

A
  • comforts and relaxes the patient by altering pain reaction
  • increases pain threshold
  • alters patient’s perception of time (goes faster)
  • more efficient appointment
  • rapid elimination -> no driver needed
21
Q

what is TENS

A
  • TENS = transcutaneous electrical nerve stimulation
  • used in sports medicine to decrease pain cycle by increasing blood levels of serotonin and endorphins, results in increased pain threshold
  • TENS used dentally to relieve chronic pain of TMJ and myofascial pain dysfunction
22
Q

what is electronic dental anesthesia

A
  • EDA founded in 1970’s (dental version of TENS)
  • EDA used for acute pain created during dental procedures
  • uses higher frequency than TENS
  • not used a lot because it is expensive and uncomfortable
23
Q

how do we use hypnosis in dentistry

A
  • has been used as an adjunct to N2O especially in apprehensive children
  • affects the subconscious mind to receive suggestions and recall those at a later time
  • additional training required
  • patient must be open minded about hypnosis to be a good candidate
  • patients will not do anything they would not normally agree to do
24
Q

how can hypnosis be used as an adjunct to local and nitrous oxide

A
  • hypnosis alone will not eliminate pain
  • acts as a sedative
  • treatment time is also altered in patient’s mind
  • children are very receptive to hypnosis as they have open minds
25
Q

what is biofeedback for pain control

A
  • includes psychological techniques such as relaxation techniques and psychotherapy for pain control
  • clinicians require further training
  • has been known to successfully deprogram patients from bruxing and clenching
26
Q

what is acupuncture used for in pain control and what are some benefits

A
  • useful for sedation (relaxation), TMJ (ease of opening), increasing post op healing
  • benefits include lack of side effects, minimal change in treatment time, sedation without the need for a driver
  • additional training required, NB has no regulatory body for acupuncture
  • additional armamentarium - points, alcohol swabs
  • suitable for anyone except where bleeding or excessive movement is possible (but can also use acupressure)
27
Q

what is acupressure – EFT tapping

A
  • physiologically, EFT has been found to normalize brain waves, relax to trapezius, and reduce salivary cortisol levels
  • preliminary research has shown it to be promising for dental anxiety
28
Q

what is computer controlled local anesthetic delivery

A
  • regulates the rate of flow of solution (motor and microprocessor)
  • more comfortable for the patient and operator
29
Q

what is used to reverse local anesthesia and why is it used

A
  • phentolamine mesylate (alpha adrengeric receptor antagonist) reverses effects in 30 minutes
  • risk of self injury from anesthesia in soft tissues post-op (biting cheek and not feeling it)
30
Q

what is buffered local anesthetic

A
  • LA is acidic compared to tissues
  • pain during injection, slow onset of action, lack of effect in inflamed/infected tissues
  • sodium bicarbonate buffered solution raises pH to solve these problems
31
Q

what is nasal local anesthetic mist

A
  • single use intranasal spray (6 mg tetracaine HCl, 0.1 mg oxymetazoline HCl)
  • tetracaine diffuses through tissues easily
  • plural anesthesia of teeth 1-5 in affected quad, and soft tissues
32
Q

what are some longer acting agents for post-surgical pain management

A
  • neurotoxins from sealife, such as
  • tetrotoxin
  • saxitoxin
  • neosaxitoxin
  • nanoparticles and liposome microparticles
  • magnesium
33
Q

how do light-activated and inactivated local anesthetics work

A
  • optogenetics: light controls neural activity of cells

Pain Management (4 decks)

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